Homelessness Observations Reading

The Guest Who Has No Place to Live.

Inspired by this tweet (“This book is viscerally upsetting, lol. What the fuck”), I read The Guest by Emma Cline.

The inside flap offers an accurate description of the story: Alex makes a “misstep at a dinner party” and ends up wandering around Long Island. She has “few resources and a waterlogged phone, but [is] gifted with an ability to navigate the desires of others.” She is indeed “propelled by desperation and a mutable sense of morality” and “a cipher leaving destruction in her wake.”

And, yes, the book is viscerally upsetting.

Is the story about status and hierarchies? Yes. Is it about appearances and identity? Yes. Is it about the transactional roles young women play in American society? Yes.

Is it about a young woman who has nowhere to live? Yes: Alex is homeless.

This is not the reason why I chose to read this book. (Honestly, the only thing I knew about the book was from that tweet. We can wonder together why I wanted to read something “viscerally upsetting”).

It’s not Alex’s status as a homeless person that turns the stomach. (I don’t even know how many readers use the frame of homelessness while reading this story.) It’s the odious nature of her choices, how unsettling her behavior is. She is not endearing. (Kudos to Cline for creating a character who is unlikeable yet compelling.) We readers get caught up in the appearances of luxury and decadence that we forget that Alex is trying to find a stable place to live.

We never learn Alex’s backstory; we don’t know where she is from, what happened to her in the more distant past, or how she came to behave this way. Part of the point of the novel, I think, is that we can never know: Appearances are what matter. You can tell any story you want to get your needs met.

For readers who want to make their lives more difficult (…), this book introduces uncomfortable questions related to homelessness:

  • If a young woman is despicable, does she deserve to be homeless?
  • What do we want to happen to young women we don’t like? Do we want them to suffer? Is homelessness a sufficient punishment?
  • Do we therefore assume that all people who are homeless must have done terrible things?

Then there’s the question of redemption. The events of The Guest unfold over the course of one week. Do we think Alex could ever redeem herself? What if it takes a year? or five?

Should people who are unlikeable be homeless until they redeem themselves?

Maybe Alex is a cipher, but, more importantly, she has no place to live. That’s why she’s “propelled by desperation and a mutable sense of morality”. Perhaps we take comfort in the idea that Alex is a character, that this is a novel.

  • Would we make similar choices if we were in Alex’s situation?
  • Could we also do such unlikeable things if we were homeless?

What if the homeless young women we encounter aren’t anything like Alex? Might we want to make different choices ourselves?

(And, yes, to be clear, I do recommend The Guest.)

Blogosphere Lessons Nonfiction Reading Reflection

Time Millionaires, etc.

A cartoon illustration of a father and son aging together, from birth to the grave.
Artwork by Pascal Campion

Since my last post, I have recovered from illness, though spasms of coughing still occasionally overtake me. Other circumstances have changed, too, that have highlighted to me the importance of spending time with people we love. American culture often focuses on becoming financial millionaires when becoming time millionaires is vastly more important.

Here are some things I read while recuperating that may be of interest to you:

What My Father’s Martial Arts Classes Taught Me about Fighting Racism. “Self-defence means to protect yourself, to protect others around you, and to protect your opponent from committing a crime.”

The Politics of Paying Real Rent Duwamish. This is of greatest interest to people who live in the Seattle-King County area. After reading this article I stopped paying Real Rent. The tagline is accurate: “Why a simple act belies a complicated history.”

“A 1996 Super Mario 64 manga suggests that 1-Up Mushrooms grow from the bodies of dead Marios, perpetuating the cycle of life and death.” The image is what drew me in.

What It Felt Like to Almost Die. “My near-death experience taught me not to fear those final moments.” I hope that this is true for us all.

Generation Connie. I am a bit older than the cohort of Asian American women who were named Connie (and my father said that my parents never considered the name Connie for me), though I definitely remember seeing Connie Chung with Dan Rather when I was growing up. Fun photos in the article.

A Killing on the F Train. Of all the writing I’ve read about Jordan Neely, the man experiencing homelessness and psychiatric symptoms in NYC who died when another subway passenger restrained him (via chokehold), this piece by John McWhorter resonates the most with me. His perspective is kind, nuanced, and empathic. Highly recommended.

Consult-Liaison Reading

Biased Thoughts.

The only social media platform I have yet to abandon is Twitter. It’s a good example of “variable ratio reinforcement”. Think of a slot machine: People put money into it with hopes of winning a jackpot. A reinforcer increases the likelihood that a specific behavior will happen. Here, the reinforcer is the pay out. The chance of a jackpot makes it more likely that someone will stay and continue to put money into the slot machine. However, the slot machine doesn’t pay out money on a predictable schedule or ratio. Jackpots happen on a variable schedule. This “variable ratio reinforcement” is what keeps people at slot machines (a specific behavior) for hours.

The Twitter algorithm occasionally (on an unpredictable, variable schedule) shows me interesting and useful information. It recently introduced me to a paper called Toward Parsimony in Bias Research: A Proposed Common Framework of Belief-Consistent Information Processing for a Set of Biases. (Though the paper isn’t too jargony, it is wordy… but worth your attention if you like this sort of stuff.) Of course, this paper played right into my biases: I like parsimony (or, more simply put, in a world of Lumpers and Splitters, I am generally on Team Lumper) and I like thinking about biases and how they affect our emotions and behaviors.

The authors argue that bias is embedded in every step we take when we process information. We already have a set of beliefs. Unless we exert deliberate effort, our thinking habits automatically try to confirm what we already believe. This bias manifests in what we pay attention to, how we perceive things, how we evaluate situations, how we reconstruct information, and how we look for new information.

The authors also put forth the idea that most of our biases are forms of confirmation bias. (The list of biases is biased towards Splitters; see this enormous list of cognitive biases on Wikipedia.) As Lumpers, the authors distill common biases down to two:

  • “My experience is a reasonable reference.”
  • “I make correct assessments.”

As a result, they argue that we can significantly reduce our biases “if people were led to deliberately consider the notion and search for information suggesting that their own experience might not be an adequate reference for the respective judgments about others” (see comment above about article wordiness) and “if people deliberately considered the notion that they do not make correct assessments”.

My mind then ties these biases into the primary framework of cognitive behavioral therapy (CBT). CBT is a type of psychotherapy that focuses on identifying and changing thoughts to then alter emotions and behaviors. The three “categories” of “thought targets” include:

  • core beliefs (things we believe about ourselves, other people, and the world that come from our past experiences)
  • dysfunctional assumptions (we tend to believe “negative” things, rather than “positive” things)
  • automatic negative thoughts (these are “habits of thought” that we are often unaware of; much of CBT focuses on recognizing and identifying these thoughts)

(This is a common complaint about CBT: “So you’re telling me that my problem is that I think ‘wrong’ thoughts. Thanks a lot.”)

If it is true that biases can be reduced to only two, then can we assume that these two beliefs—that we ourselves are reasonable reference points and that we make correct assessments—should be common “thought targets” in CBT? Instead of chasing down every single “automatic negative thought”, could we instead focus on these two common beliefs? (I see value in reframing it this way. Labeling something as an “automatic negative thought” can preclude the value that the thought has in our daily lives. For example, I might have the automative “negative” thought, “I am not entirely safe when I go outside.” However, this automatic thought—which may have led me to take self-defense classes and always monitor my surroundings—may have contributed to me staying out of harm’s way. Astute readers will note that my example included the word “entirely”. It is up for debate about whether the inclusion of that word makes it an adaptive, nuanced thought or a true “negative” automatic thought.)

Focusing on these two beliefs seems to tread into Buddhist psychological thought, too. From a lens of impermanence, are thoughts even real? Can they be sustained? Our ideas—our thoughts—can be reasonable in one moment, and completely unreasonable in the next. Same with our assessments: New data and new context can make our assessments wrong in a moment. And what about non-self? Can we even speak of “my reasonable reference” and “my correct assessments” if, in fact, there is no “self”? And aren’t thoughts yet another concept that keep us trapped in suffering?

So, I think there are three main ideas to take from this post:

  • Twitter has some value, some of the time, and is an excellent demonstration of variable ratio reinforcement.
  • You might be able to significantly reduce your cognitive bias if you adopt two habits of thought: (1) Look for evidence that your own experience is inadequate when assessing other people and situations, and (2) Look for evidence that you do not make correct assessments.
  • An oldie but goodie: You can’t always believe what you think.
COVID-19 Medicine Nonfiction Public health psychiatry Reading

Things That Made Me Smarter This Week.

Some media recommendations for your consideration:

Three Years Into Covid, We Still Don’t Know How to Talk About It. This article is one of the few that resonated (more) with my experience of the Covid-19 pandemic. Despite my professional training and expertise as a psychiatrist, I still can’t find the “right” words to describe what happened to me, the people around me, and the world. Without adequate words to create a coherent narrative of my experience, I still don’t fully understand what happened. (I hope that I will not give up trying.)

Freedom House Ambulance: The FIRST Responders. Did you know that the first modern ambulance service in the United States was developed in a Black neighborhood in Pittsburgh? The Freedom House Ambulance served as a model for the rest of the world.

This Book Changed My Relationship to Pain (title of the podcast, not my comment). Dr. Zoffness explains the bio-psycho-social nature of pain in an engaging way with plain language. (I am one of the many people she describes in the podcast who developed chronic pain during the pandemic; I have known since its arrival, both as a professional and as a human being, that there is significant a psychological component.) Pain is not all in your head AND the state of our minds affects how we experience pain.

Mathematician Explains Infinity in 5 Levels of Difficulty. I have always found math interesting. What I particularly enjoyed in this video is the skill Dr. Riehl shows in teaching the concept of infinity to different audiences. This is something I aspire to (and have mused about doing something like this for myself for psychiatry, à la the “Feynman Technique“). I also appreciated the similarities between the explanations she provided at level one and level five.

Salve Lucrum: The Existential Threat of Greed in US Health Care. When I read things like this, I see yet another pathway that someone can unwillingly tread upon that will result in homelessness. (Some people think they are immune to homelessness; that’s just not true.) “… unchecked greed concentrates wealth, wealth concentrates political power, and political power blocks constraints on greed”, and “[g]reed harms the cultures of compassion and professionalism that are bedrock to healing care.”

Blogosphere Reading

Notables from This Week.

Happy Lunar New Year! May the Year of the Rabbit bring you health, wealth, and peace. I send specific wishes of safety and serenity to those who are afflicted by war. Some cultures believe that there is a rabbit in or on the moon. I hope that those who are living through war know that, when they look at the (rabbit on the) moon, there are other people on the planet who are also looking at the moon and pray for them.

What to Do If a Rat Comes Up Your Toilet. This is actual guidance (in cartoon form!) from the Seattle-King County Public Health Department. Some regions have experienced flooding due to the rivers of rain running through the sky. May you never have to deal with this problem, but if you do, now you know how to proceed.

Donations to Cover DNA Testing. This is an actual headline in the Seattle Times: Investigators ask public to fund DNA testing on foot found near Port Angeles. I learned a number of facts here:

  • “If a body sinks and decomposes underwater, scavengers begin feasting — often picking at the soft ligaments and connective tissues of human ankles first, causing the feet to become separated.”
  • “Changes in sneaker design since 2007 have made shoes more buoyant, as manufacturers began using lighter foam for soles.”
  • “Since 2007, nearly two dozen human feet in sneakers have washed up along the coasts of the Salish Sea in the U.S. and Canada.”

It is a travesty of justice that law enforcement agencies need “to crowdfund or seek donations from philanthropists” to help identify a deceased person.

The Enduring, Invisible Power of Blond. The incisive and provocative Tressie McMillan Cottom wrote this piece that ostensibly is about the power of blondness; the key quote is this: “When people have outsize emotional reactions to benign inquiries about their self-evident beliefs, it is often an indicator that status is doing invisible work.” Though there are some loud, public pushes to encourage (or cajole or threaten or berate) people to recognize their prejudices and change their behaviors, meaningful shifts actually result from quiet, internal effort. Recognizing and reflecting on “outside emotional reactions” are opportunities, as some say, “to do the work”.

Recommended: Dr. Bill Gardner’s Substack. I first started reading Dr. Gardner’s writing many years ago on the health services blog, The Incidental Economist. He now shares his thoughtful wisdom on I Have Serious News…. Much of his current writing focuses on his cancer diagnosis. He continues to write with clarity, compassion, and insight. If you seek inspiration about clear communication about health, both on individual and population levels, consider subscribing to his Substack.